title: Prevention and treatment of bone changes associated with exposure to glucocorticoids.
abstract: Rheumatologic diseases are associated with a proinflammatory state, which is thought to lead to many of the bone changes seen in treatment-naive patients. However, glucocorticoids remain a common treatment option for rheumatologic diseases and are known to have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Despite the anti-inflammatory effect of glucocorticoids, fracture risk rises within the first 3 months of treatment. As such, osteoporosis prevention and treatment needs to be considered in all patients started on chronic glucocorticoids (≥3 months of treatment). For very low risk patients, conservative management with non-pharmacologic strategies may be appropriate. For the moderate to high fracture risk patients treated with glucocorticoids, pharmacologic treatment with 1 of the 4 approved medications should be considered. The challenge of educating physicians and patients of the risks of glucocorticoid induced osteoporosis remain.
authors.affiliation: Division of Endocrinology, Metabolism and Diabetes, University of Alabama at Birmingham, 702 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35233, USA, warriner@uab.edu.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Warriner
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
mesh_terms: D015519:Bone Density / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D050723:Fractures, Bone / Q000188:drug therapy* / Q000517:prevention & control*; D005938:Glucocorticoids / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy* / Q000517:prevention & control*; D012216:Rheumatic Diseases / Q000188:drug therapy; D012307:Risk Factors; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D004164:Diphosphonates; D005938:Glucocorticoids; D014807:Vitamin D; D002118:Calcium